Study finds lethal injections often painful for inmates

As many as four of every 10 prisoners put to death in the United States might receive inadequate anesthesia, causing them to remain conscious and experience blistering pain during a lethal injection.

Researchers in Florida and Virginia drew this conclusion after reviewing levels of anesthetic in the blood of 49 inmates after they were executed.

"I approached this as a physician," said the study's lead author, Dr. Leonidas Koniaris, chairman of surgical oncology at the University of Miami. "We were asking: Is there a possibility of awareness during an execution? Is there a large degree of pain and suffering associated with it? And I think the answer we found is yes."

Of the inmates studied in a report published by the British journal The Lancet, 43 percent had concentrations of anesthetic in their blood — as measured by medical examiners during autopsies — that would indicate consciousness rather than sedation during an execution.

Koniaris, who says he does not oppose the death penalty, thinks the study warrants a moratorium on executions until a publicly appointed panel can review whether some inmates remain conscious during lethal injection.

"If that's the case, as a society we need to step back and ask whether we want to torture these people or not," he said.

Death penalty supporters dismissed the suggestion of a moratorium.

"Lethal injection represents the most humane possible means of punishing a brutal, heinous murderer," said Andy Kahan, Mayor Bill White's advocate for crime victims "Whether or not it is painful, one thing is for sure, it is certainly less painful than the excruciating and horrific death that the victim suffered at the hand of the defendant."

The anesthetic, sodium thiopental, is the first of three drugs given in the execution protocol used by Texas and most other death penalty states. The amount typically administered through an IV, 2 to 3 grams, is far more than the amount used to sedate surgical patients and, doctors say, should prove fatal by itself.

Yet, some death penalty critics say poorly trained executioners — most have no formal anesthesia training — could miss a vein or otherwise err in administering a dose. The anesthetic also could wear off during a prolonged execution, which typically last at least 8 minutes.

If the anesthetic somehow fails and an inmate regains consciousness, the second step of a lethal injection, administration of a muscle relaxant, paralyzes the muscles and lungs. The third drug given is potassium chloride, a toxic agent that stops the heart.

The implications of an ineffective anesthetic are, in the words of a Lancet editorial accompanying the article, troubling: "It would be a cruel way to die: awake, paralyzed, unable to move, to breathe, while potassium burned through your veins."

Argument for a stay

The potential inhumanity of lethal injection is sometimes raised by lawyers trying to win a last-minute reprieve for their death-row clients.

In December 2003, Texas killer Kevin Lee Zimmerman had his execution stayed after his lawyers argued that the lethal-injection procedure masked severe pain and thus constituted cruel and unusual punishment.

The U.S. Supreme Court soon lifted its stay, and Zimmerman was executed six weeks later. Still, death penalty lawyers say courts may reconsider the issue if more evidence, such as that in the new study, is presented to suggest that executions are extremely painful.

The study reviews the blood records of inmates from Arizona, Georgia, North Carolina and South Carolina. Texas, the national leader in executions, refused to provide data for the study.

A critical question, the study authors admit, is whether measurements of the levels of sodium thiopental in the blood minutes or hours after death correlate with levels in the blood at the time of execution. However, they note that sodium thiopental levels remain stable in stored human blood.

A local anesthesiologist, Dr. Lydia Conlay, said the extrapolation of postmortem sodium thiopental levels in the blood to those at the time of execution is by no means a proven method.

"It's an interesting and thought-provoking study," said Conlay who chairs the department of anesthesiology at Baylor College of Medicine. "I just don't think we can draw any conclusions from it, one way or the other. I just can't be sure what the numbers mean."

Some opponents of the death penalty say the public accepts lethal injection as a painless medical procedure because, with the IVs, it appears to be one.

"The bottom line is that the there's a real problem with the perception of how lethal injection goes down in the public, and what we believe really goes on," said Gary Clements, deputy director of the Capital Post-Conviction Project of Louisiana, a group that represents death row inmates.

Lack of data and records

The study's authors said this question of whether an inmate can feel pain ultimately can't be answered because of the unwillingness of states to maintain or share their execution data and records.

In addition to asserting that the TDCJ had no autopsy or toxicology reports for inmates executed by lethal injection, Texas officials told the researchers it did not even have records of how it created the protocol it uses for injections.

Another of the study's authors, University of Miami anesthesiologist Dr. David Lubarsky, said the research team would have greatly preferred to use blood data from inmates at the time of executions. But the data doesn't exist, or it wasn't provided, Lubarsky said.

"What we do have is data to suggest the process might be critically flawed," Lubarsky said. "It's now up to the corrections systems to show that, at the time of death, inmates are asleep. We should accept no less when we're killing people."